Lotions Can't Prevent Rosacea

Q:  My dermatologist once told me, "I can pick out women who are 25 years old and know that in later years they will have rosacea." At the time, she didn't mention that she thought I would get rosacea, but now, in fact, she has given me the diagnosis.

Could I have used creams earlier to prevent the condition or to keep it from getting worse? Should she have even told me she can tell in advance who is likely to get rosacea?

A:  Rosacea is a relatively common skin condition of unknown cause. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), approximately 14 million people in the US have rosacea. It most often affects adults between the ages of 30 and 60 and is more common in women (particularly during menopause) than men.

The disorder is characterized by redness, pimples, and, in advanced stages, thickened skin. Rosacea usually affects the face; other parts of the upper body are only rarely involved.

Rosacea usually occurs in fair-skinned people, starting anywhere from age 30 to 60. Frequent flushing of the center of the face - which may include the forehead, nose, cheeks, and chin - occurs in the earliest stage of rosacea. The flushing often is accompanied by a burning sensation, particularly when creams or cosmetics are applied to the face. Sometimes the face is swollen slightly.

People with rosacea might first notice a mild redness of the nose and cheeks and very small red marks on the cheeks, then skin changes that look like acne, and finally, some people (mostly men) see an enlargement of the nose, called rhinophyma.

In addition to skin problems, up to 50% of people who have rosacea have eye problems caused by the condition. Typical symptoms include redness, dryness, itching, burning, tearing, and the sensation of having sand in the eye.

Doctors do not know the exact cause of rosacea but believe that some people may inherit a tendency to develop the disorder. People who blush frequently may be more likely to develop rosacea. Some researchers believe that rosacea is a disorder in which blood vessels dilate too easily, resulting in flushing and redness.

Factors that cause rosacea to flare up in one person may have no effect on another person. Although the following factors have not been well-researched, some people claim that one or more of them have aggravated their rosacea: heat (including hot baths), strenuous exercise, sunlight, wind, very cold temperatures, hot or spicy foods and drinks, alcohol consumption, menopause, emotional stress, and long-term use of topical steroids on the face.

Barbara Wilson, MD, a dermatologist at the Medical College of Wisconsin, tells me that dermatologists can recognize "rosacea-prone skin," often in individuals of Northern European descent who flush or blush easily in response to emotional triggers, alcohol or spicy foods. But rosacea is not preventable - that is, a cream would not have averted your skin changes.

However, sun damage can accelerate rosacea, and harsh skin products like buffing products and acid peels should be avoided in rosacea-prone individuals. You should use a high-SPF (sun protection factor) sunscreen and only gentle skin cleansers.

Although there is no cure for rosacea, it can be treated and controlled with help from your dermatologist. Some doctors will prescribe a topical antibiotic, such as metronidazole, which is applied directly to the affected skin. For people with more severe cases, doctors often prescribe an oral antibiotic. It may take several weeks or months of treatment before a person notices an improvement of the skin.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.